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General NPI Number Information
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NPI Number | 1710151378
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Entity Type | Individual
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Provider Name | KALYAN C.C. ALURI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 4630 W JEFFERSON BLVD STE 8
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City | FORT WAYNE
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State | IN
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Zip | 46804-6800
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Country | US
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Telephone | 260-547-7543
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Fax | 260-234-3295
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Provider Business Mailing Address
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Address Line | 4630 W JEFFERSON BLVD STE 8
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City | FORT WAYNE
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State | IN
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Zip | 46804-6800
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Country | US
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Telephone | 260-547-7543
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Fax | 260-234-3295
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MT187098
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 40518
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01064978A
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License Number State | IN
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